Chapter 115 Urinary Incontinence

Question 1

Anterior vaginal wall prolapse

Answer 1

Most common compartment involved in POP; associated with cystocele and stress urinary incontinence

Question 2

Occult stress urinary incontinence

Answer 2

Leakage is masked by prolapse; unmasked during urodynamics with prolapse reduction

Question 3

Urethral hypermobility

Answer 3

Q-tip test >30°; suggests mobile urethra → treat with mid-urethral sling

Question 4

Integral theory

Answer 4

SUI caused by loss of vaginal support and tension transmission; basis for mid-urethral sling

Question 5

Pressure Transmission theory

Answer 5

Basis of Burch colposuspension; lifting bladder neck restores intra-abdominal pressure zone closure

Question 6

Mid-urethral sling

Answer 6

Gold standard for uncomplicated SUI with urethral mobility, supports mid-urethra like a backboard

Question 7

Pubovaginal sling

Answer 7

ISD or fixed urethra, used autologous fascia

Question 8

Bladder perforation risk

Answer 8

higer in TVT (retropubic sling) due to blind passage behind pubic bone

Question 9

Groin thigh pain

Answer 9

TOT (transobturator sling)

Question 10

Used in POP Q to determine stage IV prolapse

Answer 10

TVL- 2 rule

Question 11

forceps - assisted delivery

Answer 11

highest obstetric risk factor for elvator ani injury -> icreased risk of POP

Question 12

Hispanic women

Answer 12

demographic group with highest prevalence of POP

Question 13

vault prolapse

Answer 13

post hysterectomy descent of vaginal apex, often presents with central bulge or dyspareunia

Question 14

CARE trial

Answer 14

UD with prolapse reduction detects occult SUI

Question 15

OPUS trial

Answer 15

Prophylactic sling decreases de novo SUI, but higher complications

Question 16

TOMUS trial

Answer 16

TVT and TOT are equally effective

Question 17

WHI data on prolapse

Answer 17

cytoscele most common, early stages my regress spontaneously

Question 18

POP Q Point Ba

Answer 18

most descended point on anterior vaginal wall, for anterior staging of prolapse

Question 19

POP Q Bp

Answer 19

most decended point on posterior wall, refelects rectocele severity

Question 20

Vaginal parity (≥4)

Answer 20

RR 10.85, strongest risk factor for POP

Question 21

Chronic constipation

Answer 21

RR OR 2.5 pop risk

Question 22

AGe >40

Answer 22

prevalence 40% per decade

Question 23

obesity

Answer 23

POP and SUI by 2.5

Question 24

ehlers danlos or marfans

Answer 24

high risk of pelvic floor laxity and pop

Question 25

Burch Colposuspension

Answer 25

Bladder neck to coopers ligament, avoids mesh

Question 26

colpcleisis

Answer 26

Vaginal closure for non sexually active women

Question 27

sacrospinous ligament fixation

Answer 27

vaginal suspension using posterior pelvic ligaments, may cause nerve injury

Question 28

Sacrocolpopexy

Answer 28

Ab procedure using mesh to suspend vaginal apex to sacrum, durable repair for prolapse

Question 29

Uterosacral ligament suspension

Answer 29

Vaginal or lap procedure, risks of ureteral kinking and cysto is required

Question 30

VLPP <60 cm H2o

Answer 30

Intrinsic Sphincter Deficiency (ISD), treat with pubovaginal sling

Question 31

most common cause of hysterectomy in older women (disease and age)

Answer 31

POP for 54 and older

Question 32

Onuf's

Answer 32

S2-S4 Pudendal Nerve, Voluntary Sphincter Control

Question 33

Nerve voluntary control of external US?

Answer 33

pudendal

Question 34

Nerve fibers that sense bladder stretch and initiate storage reflexes

Answer 34

Aδ afferent fibers

Question 35

part of brain which coordinates voluntary voiding

Answer 35

PMC

Question 36

what provides 30% of female urethral closure pressure

Answer 36

submucosal seal, which is estrogen sensitive

Question 37

anatomical structure that supports mid urethra anteriorly

Answer 37

Pubourethral ligaments

Question 38

which structure help close the female urethra from sides and back

Answer 38

compressore urethrae and urethrovaginal sphincter muscles

Question 39

what is Hammock hypotehesis (DeLancey)

Answer 39

Posterior vaginal wall and pubocervical fascia as a support hammock for urethra

Question 40

what is the integral theory of incontinence

Answer 40

due to loss of tensions transmission from the vaginal wall and ligament laxity

Question 41

what is the pressure transmission theory

Answer 41

intrab pressure should be transmitted equally to bladder and urethra

Question 42

neurologic condition can cause suprapontine DO?

Answer 42

Stroke, Parkinsons, MS

Question 43

What muscle contributes to male tonic continence post-prostatectomy?

Answer 43

external rhabdosphincter

Question 44

Incontinence occurs when:

Answer 44

1 bladder contracts inappropriately 2 outlet failure 3 poor bladder emptying

Question 45

DeLance'ys 3 level of pelvic support

Answer 45

Level I: Uterosacral & cardinal ligaments Level II: Arcus tendineus fascia pelvis (ATFP) & paravaginal attachments Level III: Perineal body, levator ani, distal endopelvic fascia

Question 46

: What type of prolapse results from loss of Level I support?

Answer 46

apical prolapse, uterine or vaginal

Question 47

Level 2 support loss?

Answer 47

anerior or posterior vaginal wall prolapse (cystocele, rectocele)

Question 48

level III support

Answer 48

urethral hypermobility, distal vaginal laxitym and SUI

Question 49

what laterally supports the mid vagina in level 2

Answer 49

arcus tendineus fascia pelvis

Question 50

3 components of pelvic support

Answer 50

ligaments, fascia, pelvic floor muscles

Question 51

provides fynamic support to pelvic organs

Answer 51

levator ani (PC, IC,PR)

Question 52

POP-Q Stage Criteria

Answer 52

1 leading point > 1 cm above hymen (eg -1.1,-2,-13) 2 leading point 1 or equal above or below hymen,( -1 to +1) 3 >1 cm below hymen (+2 to TVL -2) 4 complete eversion or leading point > or equal to TVL -1